Mild hypothermia therapy for patients with severe brain injury

Gál, Roman; Čundrle, Ivan; Zimová, Iveta; Smrčka, Martin

doi:10.1016/s0303-8467(02)00023-9

Cited by 68 publications

(45 citation statements)

References 7 publications

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“…We identified a total of 18 studies involving hypothermia for control of ICP; 13 were randomized clinical trials and 5 were observational studies as shown in tables 1 and 2 respectively [54,[58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74]. In all studies, the patient populations were comprised of TBI patients with GCS < 9 and an abnormal CT scan.…”

Section: Therapeutic Hypothermia For Icp Controlmentioning

confidence: 99%

“…In patients with ICP higher than 20 mmHg, initial (standard) treatment included appropriate sedatives, narcotics, treatment with neuromuscular blockers (for ICP control and/or shivering) and administration of hyperosmolar therapy. Neurosurgical interventions were undertaken when necessary to evacuate subdural lesions or large intracerebral lesions [58,61,63,64,[66][67][68][69][70][71][72][73][74]. In nine studies, there was no mention of the use barbiturates for ICP control [60,62,64,68,69,[71][72][73][74].…”

Section: Therapeutic Hypothermia For Icp Controlmentioning

confidence: 99%

“…In nine studies, there was no mention of the use barbiturates for ICP control [60,62,64,68,69,[71][72][73][74]. In five of the studies, therapeutic hypothermia was applied after elevated ICP failed to respond to adequate sedation, hyperosmolar therapy and barbiturates [58,63,[65][66][67]. In the other four studies [54,59,61,70], patients were randomized to hypothermia or normothermia irrespective of ICP, with the goal of studying hypothermia's role as a neuroprotectant (discussed below).…”

Section: Therapeutic Hypothermia For Icp Controlmentioning

confidence: 99%

“…Therapeutic hypothermia was maintained from 24 hrs up to 14 days depending on the study protocols. Some studies achieved re-warming passively over 10-24 hrs [67,70,71,73], but most studies achieved slow active rewarming over 12-24 hrs as shown in tables 1 and 2. In one study, hypothermia maintenance for five days was associated with less rebound ICH than hypothermia for two days [72].…”

Section: Therapeutic Hypothermia For Icp Controlmentioning

confidence: 99%

See 3 more Smart Citations

Therapeutic Hypothermia in Traumatic Brain Injury

Sadaka¹,

Veremakis²,

Lakshmanan³

et al. 2013

Therapeutic Hypothermia in Brain Injury

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Section: Therapeutic Hypothermia For Icp Controlmentioning

confidence: 99%

Section: Therapeutic Hypothermia For Icp Controlmentioning

confidence: 99%

Section: Therapeutic Hypothermia For Icp Controlmentioning

confidence: 99%

Section: Therapeutic Hypothermia For Icp Controlmentioning

confidence: 99%

See 2 more Smart Citations

Therapeutic Hypothermia in Traumatic Brain Injury

Sadaka¹,

Veremakis²,

Lakshmanan³

et al. 2013

Therapeutic Hypothermia in Brain Injury

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“…Ten were single centre studies [10,12,14,16,17,20,22-25], three (all performed in China) [14,20,22] were multi-centre. Four additional studies [11,15,18,21] observed a trend to improved outcome, but these differences were not statistically significant.…”

Section: Introductionmentioning

confidence: 95%

European society of intensive care medicine study of therapeutic hypothermia (32-35°C) for intracranial pressure reduction after traumatic brain injury (the Eurotherm3235Trial)

Andrews

Sinclair

Battison

et al. 2011

Trials

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BackgroundTraumatic brain injury is a major cause of death and severe disability worldwide with 1,000,000 hospital admissions per annum throughout the European Union.Therapeutic hypothermia to reduce intracranial hypertension may improve patient outcome but key issues are length of hypothermia treatment and speed of re-warming. A recent meta-analysis showed improved outcome when hypothermia was continued for between 48 hours and 5 days and patients were re-warmed slowly (1°C/4 hours). Previous experience with cooling also appears to be important if complications, which may outweigh the benefits of hypothermia, are to be avoided.Methods/designThis is a pragmatic, multi-centre randomised controlled trial examining the effects of hypothermia 32-35°C, titrated to reduce intracranial pressure <20 mmHg, on morbidity and mortality 6 months after traumatic brain injury. The study aims to recruit 1800 patients over 41 months. Enrolment started in April 2010.Participants are randomised to either standard care or standard care with titrated therapeutic hypothermia. Hypothermia is initiated with 20-30 ml/kg of intravenous, refrigerated 0.9% saline and maintained using each centre's usual cooling technique. There is a guideline for detection and treatment of shivering in the intervention group. Hypothermia is maintained for at least 48 hours in the treatment group and continued for as long as is necessary to maintain intracranial pressure <20 mmHg. Intracranial hypertension is defined as an intracranial pressure >20 mmHg in accordance with the Brain Trauma Foundation Guidelines, 2007.DiscussionThe Eurotherm3235Trial is the most important clinical trial in critical care ever conceived by European intensive care medicine, because it was launched and funded by the European Society of Intensive Care Medicine and will be the largest non-commercial randomised controlled trial due to the substantial number of centres required to deliver the target number of patients. It represents a new and fundamental step for intensive care medicine in Europe. Recruitment will continue until January 2013 and interested clinicians from intensive care units worldwide can still join this important collaboration by contacting the Trial Coordinating Team via the trial website http://www.eurotherm3235trial.eu.Trial registrationCurrent Controlled Trials ISRCTN34555414

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